How the Health Insurance Industry Is Uniquely Positioned to

Implement Digital Health Interventions and Preventative Care

Measures

Bea Franziska Frese

1,2

School of Medicine, University of St. Gallen, St. Gallen, Switzerland

Future Health Technologies, Singapore-ETH Centre,

Campus for Research Excellence and Technological Enterprise (CREATE), Singapore

Keywords: Health Insurance, Digital Health Interventions, Prevention, User Engagement, Platform Business Model,

Innovation, mHealth.

Abstract: Digital Health Interventions (DHIs) provide promising solutions for a variety of use cases, especially mobile

DHIs as they leverage readily available technologies. Such solutions have enormous potential for preventative

care measures through collecting and analysing data to provide personalized support at scale. This paper looks

at one such DHI from the health insurance industry that seeks to engage people continuously with healthy

lifestyle behaviours. Referencing learnings from Asian markets and industry professionals, this paper

illustrates how health insurance companies are uniquely positioned to fulfil this potential based on their

objectives, long-term outlook, and access to health data. It also elaborates on the required skillsets to build

impactful DHIs, highlighting gaming theories and how they can be implemented in DHIs to engage users

long-term. Further, the paper illustrates how the impact of these DHIs can be quantified through Key

Performance Indicators (KPIs) in the short- and long-term for health insurance companies. Finally, the paper

suggests how these learnings can inform future DHI approaches, including a need for flexible offerings, the

integration of mini-DHIs, and the continuous evaluation based on KPIs, as well as relevant research directions.

1 INTRODUCTION

Digital Health Technologies have a wide variety of

application areas in the health insurance industry,

creating opportunities for time and cost savings,

ranging from optimizing claims management to

leveraging Digital Health Interventions (DHIs)

(Asian Development Bank, 2021). DHIs “include any

health service or treatment delivered using

technology that aims to facilitate, capture or exchange

knowledge” (Soobiah et al., 2020). In this position

paper, we will exclusively refer to DHIs that are

based on mobile applications. These DHIs use readily

available technologies, specifically smartphones, to

provide healthcare services in a scalable way. Mobile

solutions represent a unique opportunity for insurers

to leverage digital direct-to-customer pathways,

create customer insights through data analysis and

thereby inform product innovations as well as

differentiation compared to competitors (Chung et al.,

2023).

Regulation in the field of DHIs is upcoming

worldwide and reimbursement guidelines are still

unclear. In Asia-Pacific, policymakers believe the

reimbursement pathway to be at a beginner to

intermediate stage, demonstrating a need for a fit-for-

purpose framework. In Singapore for example, the

reimbursement pathway for digital health solutions

and medical devices is the same; further, many

approved technologies either need to be paid private

or are not subject to reimbursement at all (Eversana

& APACMed, 2023). The diversity of DHI categories

further contributes to the complexity of regulatory

frameworks. According to the Digital Therapeutics

Alliance, such technologies can be categorized into

five broad categories. One category focusses on

systems and support for enterprises, one on clinicians,

and three categories are most relevant to patient-

facing DHIs: wellness and support, diagnostics and

monitoring, and therapeutic interventions (Digital

Therapeutics Alliance, 2023). The target group for

DHIs thereby varies from specific patient populations

to DHIs that can be adapted by the mass market for

Frese, B.

How the Health Insurance Industry Is Uniquely Positioned to Implement Digital Health Interventions and Preventative Care Measures.

DOI: 10.5220/0012402000003657

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 17th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2024) - Volume 2, pages 879-885

ISBN: 978-989-758-688-0; ISSN: 2184-4305

879

areas such as prevention. In mass markets, DHIs

benefit from their ability to provide scalable and

tailored services. In the area of prevention, they can

for example support efforts to coordinate

vaccinations or prevent overmedicalization at scale,

translating into significant improvements in primary

care settings (Willis et al., 2022). Based on these

differences and local regulations, a variety of

business models have been developed to solve

healthcare challenges with DHIs.

In this environment, health insurance players

have been uniquely positioned to be at the forefront

of offering DHIs. To give further insights, this

position paper showcases the experience of one such

example from the insurance industry, the global

insurance consultancy ReMark. ReMark is SCOR

Digital Solutions’ provider and has a focus on

developing digital products and services. SCOR itself

is among the world’s largest reinsurers with 4,000+

clients and operations in 80+ countries (ReMark,

2023a). One of its core InsurTech solutions is the

health and wellness DHI Good Life (see appendix,

figure 1). The app helps users make healthier lifestyle

choices in the short-term and reduce disease in the

long-term as a preventative measure by combining

five pillars: physical activity, sleep habits, mental

health, social health, and nutrition (ReMark, 2023e).

Good Life has been chosen as a focus in this paper

due to its large user base in Asia of more than half a

million users (V. Shi, personal communication,

January 9

, 2024) and the international recognition it

has received through winning the iF Design Award

for its app interface in 2023 (ReMark, 2023c).

ReMark offers Good Life as a white label solution

to companies, primarily health insurers, who in turn

can decide how to configure the solution and offer it to

their customers and the public in general (ReMark,

2023b). Users interact with the app by setting up a

profile and connecting their health data (including

physical activity, sleep duration, calories burned).

Based on this information and the specific

configuration of the solution, Good Life provides users

with insights into their health lifestyle and access to a

variety of insurance protection tailored to their health

risk profile. Users can also gain access to a portfolio of

healthcare services tailored to their needs.

This position paper has been written in

collaboration with Vincent Shi, Head of Greater

China and SEA for ReMark. The objective is to share

experience from Asian markets on the use of DHIs,

including further information from the Singaporean

market, and give an insight into the development and

deployment of the Good Life DHI.

2 DISCUSSION

The future role of the health insurance industry arises

from the challenges faced by the healthcare system

today. In Singapore, for example, the healthcare

system is under pressure to manage the ever-growing

cost attributed to several factors: aging population,

increasing health insurance costs with age, increase in

chronic diseases, and burden on families to cover

medical expenses. To counteract these factors,

Singapore has published the Healthier SG initiative.

As part of this initiative, proactively preventing

diseases has become one of the major objectives to

reduce the burden on individuals, their families,

improve quality of life, and slow down the increase

of healthcare expenditure over time (Ministry of

Health Singapore, 2022). These efforts are being

translated into a range of policies as for example

reimbursing healthcare providers for preventative

measures (Lee, 2022). Generally, preventative

measures involve behavioural change, a process that

needs engagement over a prolonged period to ensure

sustainable, healthy behaviours replace less healthy

ones.

2.1 Positioning of Health Insurance

Industry

In such a system, that is focused on offering effective

prevention measures, the role of health insurance

providers will be re-defined. This shift presents a key

opportunity, as health insurers are uniquely

positioned:

• Aligned Objectives: The health insurance

industry is incentivized to keep the number of

insurance claims low, which in turn relates to

lower healthcare costs. The link between

upfront healthcare investments and downstream

savings has been clearly established, even if

savings can only be seen in the long-term

(Agana et al., 2019; Friedberg et al., 2010).

• Long-term Outlook: Insurers are following a

sustainable business model which is currently

not reliant on prevention measures. This is a

clear benefit as long-term follow-ups are needed

to understand how each preventative care

measure affects health outcomes. In other

words, they can survive in the market long-term

while simultaneously taking investments to trial

preventative care measures that might benefit

them in the long run and prepare them for

market changes in the future.

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• Data Access: Insurers can collect data directly

from customers via their DHIs and have access

to important Key Performance Indicators (KPIs)

like claims filed to investigate the effectiveness

of measures on different aspects of a customer’s

life. This also enables them to investigate which

short-term KPIs can be correlated with long-

term health outcomes.

To further showcase how these three aspects

make health insurance players stand out, one can

consider the case of healthcare providers and start-

ups. Healthcare providers might have a long-term

outlook, but they do not have comprehensive data

access to the public outside the healthcare setting;

once people from the public interact with healthcare

providers, it is often too late for preventative

measures. Another example is start-ups, who might

be aligned in objectives and are able to create systems

to gain data access, but they do not have the long-term

breath needed to see changes in real-world health

outcomes.

2.2 Creating Engaging Offerings

While health insurers therefore can create impact with

preventative measures, especially when leveraging

DHIs to increase data accessibility, it is also

important to consider what additional skillsets are

needed to establish a sensible offering in their

ecosystem. In the Singaporean context, both public

and private healthcare providers have included DHIs

into their offering to digitize processes such as

booking appointments or distributing test results

(Fullerton Health, 2023; SingHealth, 2023).

However, digitizing traditional healthcare processes

which happen periodically does not translate into

engaging the public with preventative measures

continuously. Healthcare providers and health

insurers have limited experience with creating an

engaging offering that supports behavioural change in

the long-term.

Service providers such as ReMark with years of

experience in developing DHIs can bridge this gap by

using engagement approaches that achieve long-term

adherence for users, allowing for continuous data

collection, and the opportunity to provide feedback as

well as create tailored offerings. To reach this point,

ReMark has translated features that are proven to

engage users from the world of gaming into Good

Life. The two overarching theories in Good Life are

the Flow Theory and Hook Theory:

• Flow Theory: Based on Csikszentmihalyi

(1975), the difficulty of an activity needs to

increase over time to achieve habit formation;

thereby, challenging users just enough to keep

them interested instead of challenging them too

little so they get bored or challenging them too

much so they get too anxious. In Good Life, the

app’s response is tailored to a user’s activity and

engagement level. When users level up, the app

gradually sets more tasks and goals, resulting in

steady and realistic lifestyle improvements,

which primarily focus on users’ activities

outside the app in the real world.

• Hook Theory: Based on Eyal and Hoover

(2014), habit formation can be achieved through

a four-step ever-repeating process: trigger,

action, reward, and investment. In Good Life,

users are triggered by the app for certain

lifestyle behaviours, which results in an action

for the users to complete the tasks and

challenges. The app then provides users with

rewards which can be redeemed through a

partner marketplace. This results in users

realizing the value of their investment and

creating a self-perpetuating cycle of behavioural

change. The theory mainly targets users’

engagement in the app and motivates them to

continue using it long-term.

In combination, these theories help to create

behavioural change in the real world while engaging

users simultaneously with the app itself. This

approach is further supported by features that are

dominant in gaming. For example, Good Life

includes features to configure avatars and level up.

There are also different elements of social play that

have been integrated, leveraging external

relationships like family and friends and allowing

users to interact and compete through Good Life

(Campbell et al., 2008). Through this combination of

rewards, challenges, feedback, competition, levels,

and avatars, the DHI covers the most common game

features found in the health domain. (Hammady &

Arnab, 2022).

2.3 Making Long-Term Benefits

Visible Short-Term

Even if health insurance companies can create

engaging solutions for preventative care by

leveraging DHIs, such initiatives start out being

investments for the companies. The key question is

how KPIs can be used to quantify DHIs’ positive

impact on the bottom line in the short-term to

motivate insurers to invest in and reach long-term

health outcomes. Based on experience in Asian

How the Health Insurance Industry Is Uniquely Positioned to Implement Digital Health Interventions and Preventative Care Measures

881

markets, health insurance companies have four ways

to increase their bottom line: improve policy

persistence, sell more policies, reduce claims, and

reduce operational cost (V. Shi, personal

communication, January 9

, 2024). With Good Life,

health insurers can track the first three as KPIs to

evaluate their impact; here ranked from short- to

long-term impact:

• Improved Insurance Policy Persistence

Ratio: Customers who find Good Life useful

and enjoy using it are more engaged with the

app. They are also more likely to persist with

their insurance policy instead of switching to a

different provider. Thereby, creating sustainable

revenue for the health insurer in the short-term.

• Increased Business from Upselling, Cross-

Selling Opportunities, and Lead Generation:

Customers who engage with Good Life are more

likely to purchase additional policies from the

same insurance providers, resulting in increased

overall revenue, as well as a strong financial

incentive for users to engage with Good Life. In

certain geographies in Asia, Good Life is also

open to the public. This way, potential

customers can engage with the app, and

experience has shown that when customers learn

about the offering this way, they are more likely

to sign up for insurance policies.

• Reduced Number of Insurance Claims: In the

long-term, the higher engagement with the app

and the resulting positive lifestyle changes will

show in a reduction of insurance claims. When

an insurer reaches this point, it is financially

more sustainable for them to continue offering

Good Life.

2.4 Outlook on Future Offerings

The potential of DHIs such as Good Life goes beyond

the current offering. Rather, ReMark is seeking to

develop Good Life into a comprehensive solution for

customers; a platform that leverages highly engaging

mechanisms, while working with partners to curate an

array of effective mini-DHIs that can be integrated on

the platform. The app’s tile-based design (see

appendix, figure 1) can be flexible adapted and

expanded with mini-DHIs spanning from

preventative care to health literacy content, chronic

disease management, and beyond. To achieve this

long-term vision, Good Life seeks to become the

“most inviting” lobby that offers insurers flexibility

and personalization on one side and can integrate the

most novel mini-DHIs on the other site. Some mini-

DHIs have been developed by ReMark itself, and due

to the platform’s modular design, further integrations

of mini-DHIs by third parties can be done (V. Shi,

personal communication, October 17

, 2023).

In addition, engaging with health insurance

customers via Good Life opens opportunities for

ReMark to create insights from data that can be useful

for different stakeholders. In fact, ReMark has been

publishing an annual global consumer study, sharing

their insights on insurance consumers’ behaviour for

ten years (ReMark, 2023d).

ReMark is not alone in this strategic positioning,

leveraging the trend of increasing digitization in the

health insurance industry. As Pauch and Bera (2022)

illustrate, “the greatest source of value creation

through the digitization of insurance lies in the ability

to develop new and more customer-oriented products

and solutions to reduce costs” (p. 1682). Along these

lines, tools such as big data and mobile devices are

helpful to provide personalized experiences and

create additional sales channels, with insurance

distribution channels shifting gradually more to

include mobile channels (Pauch & Bera, 2022). Asia

is well-suited for these digitization efforts as around

half of consumers are open to buying policies via

insurers’ apps and a large majority of consumers is

open to sharing data, especially in exchange for

rewards or discounts (Ning, 2022).

2.5 Lessons Learned

Finally, ReMark and Good Life have many lessons

learned along the way. Highlighted in the following

are specifically the lessons learned based on Vincent

Shi’s experience in nine markets (personal

communication, October 17

, 2023).:

• Be Open to Trial-and-Error: Implementing

technologies that are innovative and outside of

stakeholders’ traditional business processes will

come with errors, especially for application

areas like preventative care which are

themselves fast developing. To be successful,

stakeholders must look out for the right KPIs

and be conscious of positive weak signals in the

short-term to encourage long-term commitment.

• Be Willing to Quickly Iterate: DHIs provide

an opportunity for companies to understand

what is engaging to which users through data

analysis. With this information, companies need

to be open-minded to develop solutions on-the-

go and incorporate as much customer feedback

as possible.

• Respect Local Culture Fit: Culture plays a

significant role in the uptake and engagement

with DHIs. One well-known example is mental

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health, for which acceptance between cultures

varies greatly. To take culture fit into account,

companies can collaborate with a market’s local

ecosystem, including for example healthcare

providers or start-ups, to better understand the

level of cultural adaptation required. In Good

Life, ReMark collaborates for example with

local non-governmental organizations that users

can donate their rewards to. This creates a win-

win, as users can contribute to causes that they

are connected to, and ReMark can recognise the

positive impact that users’ healthy actions have

on their community.

Through these lessons learned, ReMark has

continuously improved its offering. They and similar

service providers can bring in the lessons learned to

new projects, helping organisations to minimize

errors and reduce the number of required iterations.

3 CONCLUSIONS

ReMark is one example of how players in the health

insurance industry adapt to market realities and

provide value. In this case, the value extends beyond

the individual consumer to the healthcare system at

large by offering preventative care and leveraging

readily available technology with their Good Life

DHI. In Asian markets, specifically Singapore, they

are well positioned to fill out this role. They profit

from health insurers’ unique positioning on one side

and from bringing in expertise on engagement on the

other side. Based on ReMark’s experience, they are

further able to identify the right KPIs to convincingly

showcase the DHI’s monetary benefit in the short-

and long-term. They do so by understanding how

consumers engage with insurers and how to increase

both revenue per consumer as well as number of

consumers overall.

However, market realties vary, as exemplified by

diverse DHI categories and reimbursement

guidelines. There is no one-size-fits-all solution, and

the approach needs to be reconsidered when entering

new markets. This consideration ranges from local

culture fit to business model solutions. If health

insurers’ positioning varies regarding their

objectives, long-term outlook, or data access, they

might not be in the best position to support such

solutions either. It is therefore important that

offerings are flexible and can be quickly adapted.

Players in the health insurance industry should be

especially mindful when considering which

technologies to implement. Good Life’s tile-based

design provides an example of how a DHI’s offering

fits into this suggestion, focusing on the integration of

mini-DHIs. Integrating a variety of mini-DHIs gives

insurers the opportunity to adapt to different market

realities and personalize the offering to individual

users. Just as for the overall DHI, relevant KPIs can

be defined and tracked via a comprehensive

evaluation and adaptation process before and after

integration of mini-DHIs. The KPIs can then be used

to systematically investigate the effectiveness of

mini-DHIs as well as their impact on the overall DHI

and different user groups.

The differences related to market dynamics,

regulations, and the variety of upcoming DHIs and

mini-DHIs all lend themselves to be explored as

future research directions. It would be beneficial to

further investigate and contrast the role of health

insurance companies along these differences.

Similarly, there continue to be open questions around

how to set up the most effective DHIs for preventative

health. Good Life and the theories implemented in the

app are only one example that can be further explored

to understand the impact of individual features on

different configurations. Research could investigate

the inclusion of additional features and theories to

optimize the offering for long-term engagement and

health outcomes. In this context, it is also important

to understand to what extent the findings from the

Good Life app are transferrable to other DHIs in the

field.

ACKNOWLEDGEMENTS

Vincent Shi, Head of Greater China and SEA

ReMark, has provided the insights from ReMark

included in this position paper. Deshuo Meng, Head

of Insurance Innovation ReMark, and James

Macdonald, Senior Manager Corporate

Communications ReMark, have given feedback on

the final write-up of the paper.

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APPENDIX

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Figure 1: Screenshots of the Good Life app’s user interface.

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